Brain Health Put to the Test

Have your heard of Brain Health

If not why no go...their now!

The principle ideas is to treat to the target of no evident disease activity and you can get the big guns out at the start of the disease or you can try the escalation approach starting with the CRABs and working your way up the potential side-effect scale with more highly effective agents. 

Grants have been scare but like buses, two come along at the same time.

"When deciding on a disease-modifying treatment (DMT), persons with relapsing-remitting multiple sclerosis (PwRRMS) and neurologists are currently faced with the dilemma of adopting one of two treatment approaches: an escalation approach, starting a drug that is considered safe but with a modest likelihood to control the MS activity (attacks and new lesions), and escalating to more potent therapies in the face of continued disease activity; or an early highly effective treatment (EHT) approach, which, in contrast, involves giving a high-efficacy drug, with the rare potential for significant adverse effects, as the first-line treatment. The study population will be PwRRMS who have never been on a DMT recruited from MS treatment centers in the United States and the United Kingdom".

The trial has now been funded by PCORI  for $10,630

They obviously liked the idea so much that they have funded essentially the same trial again and the proposed study will evaluate "if the slowly worsening phase of MS can be prevented or delayed by using stronger MS treatments up front. We will perform a randomized clinical trial of 900 people with MS"...costing $13,460,000.

So the PCORI mega MS budget has now probably been spent, with another $11,000 on studies on fatigue management and exercise intervention

Some say it is a hard decision to know which treatment to take. These DMT studies hopefully will show the way forward. This study idea was put up for funding within the UK (at a fraction of the cost) a few years ago and it got knocked back. 

So the MS Society's question from the James Lind Alliance gets answered does early highly effective treatment give benefit...the answer will come in 2023.

But on the issue of decisions on treatment. A whole set of marketing shows how complex the treatments but

If you accept, which many haven't read:-(, our suggestion that they all work the same depleting memory B cells, then selection of which agents to chose then the selection becomes easier.

If you are interested in efficacy you ask which ones reduce the memory B cells the best and then you can factor in safety and convenience.

CoI. None relevant